Dr Rudick is Director, Mellen Center for Multiple Sclerosis Treatment and Research, Professor of Neurology, Cleveland Clinic Foundation, and Professor of Neurology, Ohio State University, Cleveland.
Clinical Crossroads at Beth Israel Deaconess Medical Center is produced
and edited by Thomas L. Delbanco, MD, Jennifer Daley, MD, and Richard A. Parker,
MD; Erin E. Hartman, MS, is managing editor. Clinical Crossroads section editor:
Margaret A. Winker, MD, Senior Editor, JAMA .
DR DELBANCO: Mr J is a 29-year-old, married
engineer who works in a biomedical laboratory. He was found to have multiple
sclerosis (MS) 14 months prior to this conference. Shortly thereafter, he
sought care from a general internist, Dr C, at the Beth Israel Deaconess Medical
Center and a neurologist at another medical center. He has health insurance
through a commercial managed care plan.
A few months after Mr J developed Bell palsy, which resolved fully,
he noted weakness in his right leg while skiing. The weakness progressed,
and he consulted a neurologist when he returned home. Physical examination
and magnetic resonance imaging (MRI) were compatible with demyelinating disease.
During the subsequent year, Mr J noted slowly progressive weakness associated
with exercise, again primarily involving the right leg. He experienced some
difficulty with urination, in both initiating and ending the stream. He observed
some tremor in his right foot. He experienced difficulty with sexual function
on occasion, but his bowels have not been affected. There has never been diplopia
or evidence for involvement in other parts of the body.
Rudick RA. A 29-Year-Old Man With Multiple Sclerosis. JAMA. 1998;280(16):1432–1439. doi:10.1001/jama.280.16.1432